I would not take prescription drugs for bone regeneration. Supplements, exercise, diet, lifestyle and Chinese medicine are better. Phosphate-based supplements actually destroy bone in the long run. Often the jaw is the first to go. Look up Fossy or Phossy jaw, an industrial disease from the past when people worked with phosphorus in factories. Their bones dissolved beginning with their jaws. You can Google for my posts on this subject on this forum if you are interested.
Thanks, Luminosity. I did in fact do some digging on that and found this very informative recent report in Pubmed:
Oral Bisphosphonate Related Osteonecrosis of the Jaw: A Challenging Adverse EffectThe pathogenesis of BRONJ has not been well determined. Several risk factors such as dentoalveolar surgery, therapy duration, and concomitant steroid usage have been linked to BRONJ. Conservative and surgical methods can be preferred in the treatment. Preventative measures are of great importance for the patients at high risk.
If you have a multitude of the risk factors cited, caution in using bisphosphonates seems well founded:
5. Risk Factors
There are several risk factors for BRONJ that are categorized by AAOMS as follows.
5.1. Drug Related Risk Factors
(a) Bisphosphonate Potency. Since intravenous administration leads to a higher drug exposure than the oral route, osteonecrosis related to oral bisphosphonate therapy is less common...
(b) Duration of Therapy. As oral bisphosphonates are less bio-available than intravenous formulations, they are used for long terms. Longer duration (for more than two years) has been associated with an increased risk of oral BRONJ.
5.2. Local Risk Factors
Dentoalveolar surgical procedures such as teeth extractions, periapical surgery, dental implant placement, and periodontal surgery involving osseous injury, as well as concomitant oral disease and poor oral hygiene, are risk factors for BRONJ. Additionally, as bisphosphonates have been shown to inhibit the proliferation of keratinocytes in the oral mucosa, injury of the oral mucosa due to the poorly fitting removable dental prostheses may increase the risk of BRONJ in bisphosphonate users. BRONJ due to oral bisphosphonates may occur spontaneously or more commonly after a trauma to the bone. When there is increased necessity for bone repair following a trauma, the inhibition of remodeling due to bisphosphonate therapy makes the bone vulnerable to necrosis... Local anatomy also plays a part in the development of BRONJ. Lesions are more frequent in the mandible than maxilla and more common in bony prominences with thin mucosa.
5.3. Demographic and Systemic Factors
Increased age (older than 65 years) was found to be a risk factor for BRONJ. Additionally, oral BRONJ is more common in women than men. For instance, all of the participants of a study about oral BRONJ were women. This is not an unexpected finding, since osteoporosis—particularly the postmenopausal type—is the primary indication for oral bisphosphonates. Some systemic factors such as renal dialysis, low hemoglobin, obesity, immunosuppression, rheumatoid arthritis, smoking, and diabetes were reported to increase the risk for BRONJ... Additionally, prednisone and methotrexate used in autoimmune diseases are associated with an additional inhibition of remodeling in oral bisphosphonate cases.
5.4. Genetic Factors
Single nucleotide polymorphisms in the cytochrome P450-2C gene and IGF 1 genes may play part in the pathogenesis of BRONJ...
In my wife's instance, her only risk factors are post-menopausal status and duration of treatment. I'm not sure of the genetic factors but there has never been an incident of bone necrosis in her family.
The article does cite preventative measures that might mitigate risk factors:
Prevention strategies aim to lower the risk of BRONJ. Since the risk of oral BRONJ appears to rise in treatment periods longer than 3 years, reduction this period may be helpful in patients with comorbidities such as chronic corticosteroid use. A patient with poor dental health before starting on oral bisphosphonates should be examined by a dentist in order to optimize the oral hygiene. In case of any oral surgical treatment, strategy should be based on the duration of bisphosphonate therapy, as well as concomitant drug use. No adjustment or interruption in the premeditated oral surgery is necessary for patients who have been on oral bisphosphonates for less than 3 years and have no clinical risk factors. There is also no need to evaluate the bone turnover marker levels such as serum CTX. However, patients who underwent dental implant placement procedures should be followed up regularly. Utilizing CTX along with a drug holiday or altering the dosing can also be considered. If concomitant use of steroids is present in a patient receiving oral bisphosphonates for less than 3 years whose systemic condition persist, drug holiday for at least 3 months prior to oral surgery is recommended
Although CTX is not an ultimate predictor of BRONJ, it might be useful regarding the estimation of risk prior to a surgical procedure. Deferring the planned surgery and having a drug holiday are recommended by Marx et al. if the CTX value is less than 150
pg/mL. However, when CTX level is 150pg/mL or higher, it is suggested that the patients can undergo invasive oral surgery with a minimum risk of osteonecrosis...
Following the surgery, bisphosphonates should not be prescribed till bony healing. Similarly, in cases who have been receiving oral bisphosphonate therapy for more than 3 years with or without any simultaneous prednisone or other steroid drugs, administration of oral bisphosphonates should be stopped 3 months prior to oral surgery, if systemic conditions permit... However Marx et al. do not limit oral surgery, if CTX is 150pg/mL or above. The bisphosphonate can be prescribed again when the osseous healing occurs. On the other hand, due to lack of evidence, stopping bisphosphonates prior to invasive dental procedures remains controversial.
In addition, the precise duration of pathological effects of bisphosphonates awaits to be elucidated as bone turnover markers remain suppressed for several years following discontinuation of bisphosphonate treatment. According to the American Dental Association, the decision of bisphosphonates' discontinuation should be based primarily upon the risk for skeletally related events such as fractures and secondary to low bone density, not the feasible risk of BRONJ. Additionally the use of serum CTX as a resorption marker is not endorsed by the American Dental Association.
I guess the number of one's risk factors should dictate the appropriate aggressiveness of preventative measures. In my wife's case, with minimal risk factors, I'd think scheduling a bisphosphonate holiday before scheduled dental surgury might be sufficient.
Interestingly, she did experience a recent bone fracture in her right forearm radius just below her wrist last October 31 after a slip and fall which was determined to be not BMD related... and it healed quite rapidly and well. Could be that the D3/K2/mineral supplementation scheme that she commenced a few months earlier helped.
Howard
LongeCity
